CT Screening for Lung Cancer Cost-Effective

Action Points

Using CT scans to screen older smokers who are at risk for lung cancer appears to be as cost-effective as several other common screening studies.

Point out that the cost of lung cancer screening with CT was cheaper than both breast cancer and cervical cancer screening.

Using CT scans to screen older smokers who are at risk for lung cancer appears to be as cost-effective as several other common screening studies, researchers found.

In an actuarial model analysis, using low-dose spiral CT to screen smokers and former heavy smokers, ages 50 to 64, had a cost per life-year saved similar to that for colorectal cancer screening, at about $19,000, Bruce Pyenson, of the healthcare consulting firm Milliman in New York, and colleagues reported in the April issue of Health Affairs.

That cost was cheaper than both breast cancer and cervical cancer screening, they found.

The results suggest that "commercial insurers should consider lung cancer screening of high-risk individuals to be high-value coverage and provide it as a benefit to people who are at least 50-years-old and have a smoking history of thirty pack-years or more," the authors wrote.

Most private insurers don't cover lung cancer screening, even in high-risk patients, because the data on its cost-efficacy have been limited, they explained.

However, the National Lung Screening Trial (NLST) found last year that low-dose spiral CT was associated with a 20% reduction in cancer death compared with x-ray screening.

So to test whether such screening could also be cost-effective, Peyson and colleagues created a model of spiral CT screening among smokers and long-term former smokers with at least 30 pack-years of smoking each. This study population had private health insurance and were not covered by any kind of public health insurance.

For this model, they used published, annual protocols for low-dose spiral CT lung cancer screening and follow-up visits during the subsequent year, until one of two diagnoses -- cancer or no cancer -- was made within the year following the screening. All patients received an initial screening and annual repeat screenings.

They assumed 18 million people would fall into that high-risk category, and about half would undergo CT-based lung cancer screening if it were covered -- an uptake rate comparable to colorectal cancer screening, they said.

They estimated that lung cancer screening would cost $247 per patient tested annually, assuming that three-fourths of the screenings were repeat procedures. When spread over the total commercially insured population, the total cost would be just $0.76 per insured member per month with no cost sharing, they reported.

That figure is lower than the cost of breast, colorectal, and cervical cancer screening, they said, largely because fewer lung screens involve a biopsy, and because the target population is high-risk and thus smaller than the broader populations that have the other screenings.

They also calculated that screening would lead to more than 130,000 additional lung cancer survivors in 2012.

Given those parameters, they estimated that the cost per life-year saved would be $19,000, which was on par with colorectal cancer screening, and less expensive than screening for cervical or breast cancer (about $50,000 and $31,000, respectively).

"We can jump the needle on cancer mortality for the first time in years, and do so in a cost-effective manner," Pyenson said in a statement.

The researchers noted, however, that the results of NLST were published after this analysis was completed. This model's estimates of the proportion of early-stage lung cancer that would be detected by screening, and of mortality reduction as a result of screening, are more optimistic than the results of NLST, they said.

Yet they said their patient population started at a younger age than the NLST (at age 50 instead of 55), which would have yielded fewer cancers per screened patient, potentially raising screening costs while lowering benefits.

Setting the cutoff at age 64 also underestimates cost advantages, they said, because it ignores savings after age 65.

This analysis had some other limitations: the model did not address the cost and logistics of implementing a widespread screening program. The researchers also did not factor in the cost of a possible initial surge of treatment from earlier detection, as screen-detected cancers appeared in addition to symptom-detected cancers.

"Implemented with appropriate quality and standardization processes, the screening could serve as an example of system innovation that greatly improves health outcomes without feeding cost escalation," they concluded.

The researchers reported no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.